Olfaction as an early marker of Parkinson's disease and Alzheimer's disease

Handb Clin Neurol. 2021:182:317-329. doi: 10.1016/B978-0-12-819973-2.00030-7.


Olfactory impairment is a common and early sign of Parkinson's disease (PD) and Alzheimer's disease (AD), the two most prevalent neurodegenerative conditions in the elderly. This phenomenon corresponds to pathologic processes emerging in the olfactory system prior to the onset of typical clinical manifestations. Clinically available tests can establish hyposmia through odor identification assessment, discrimination, and odor detection threshold. There are significant efforts to develop preventative or disease-modifying therapies that slow down or halt the progression of PD and AD. Due to the convenience and low cost of its assessment, olfactory impairment could be used in these studies as a screening instrument. In the clinical setting, loss of smell may also help to differentiate PD and AD from alternative causes of Parkinsonism and cognitive impairment, respectively. Here, we discuss the pathophysiology of olfactory dysfunction in PD and AD and how it can be assessed in the clinical setting to aid in the early and differential diagnosis of these disorders.

Keywords: Alzheimer's disease; Biomarker; Cognitive impairment; Dementia; Olfaction; Parkinson's disease; Parkinsonism.

Publication types

  • Review

MeSH terms

  • Aged
  • Alzheimer Disease* / diagnosis
  • Cognitive Dysfunction*
  • Humans
  • Olfaction Disorders* / diagnosis
  • Olfaction Disorders* / etiology
  • Parkinson Disease* / complications
  • Parkinson Disease* / diagnosis
  • Smell